The authors report on two cases with unusual CSF shunt complications. The first case had a peritoneal catheter which migrated down a patent processus vaginalis into a hydrocoele. The second case had an atrial catheter which perforated the atrial wall and came to lie in the pericardium causing an effusion. Clinicians should be aware of the frequent and occasionally bizarre complications of CSF shunting.

AB Jamjoom, ZAB Jamjoom, N-U-Rahman, AC Al-Rikabi, Cervical Lymph Node Metastasis from a Glioblastoma Multiforme in a Child: Report of a Case and a Review of the Literature. 1997; 17(3): 340-343 Glioblastoma multiforme (GM) does not usually metastasize outside the central nervous system (CNS), and is rarer in children than in adults.1 To our knowledge, only 11 cases of childhood GM with extraneural metastasis (ENM) have thus far been reported in the literature. [1][2][3][4] The authors report a case of a four-yearrold male patient with a GM who developed cervical lymph node metastasis seven months after the original presentation. This case and the 11 previously reported pediatric cases were grouped together and their clinical characteristics were compared with the clinical features of the 68 adult cases that have been reported in the literature up to 1995. [4][5][6][7][8] The study is an attempt to identify some of the features of ENM from GM which are unique to children. Case HistoryA four-year-old male Indian patient was admitted to the Neurosurgical Division at King Khalid University Hospital (KKUH) in April 1995 with a one-month history of headache, associated with anorexia and vomiting. On examination, the patient was inactive. He had papilledema and a left homonomous hemianopia but otherwise no neurological deficits. CT scan (Figure 1) showed a large right occipital lesion with irregular contrast enhancement, surrounding edema and mass effect. The patient underwent a craniotomy and total macroscopic excision of a vascular necrotic tumor. Histology (Figure 2) confirmed the tumor to be a glioblastoma multiforme which was focally positive to glial fibrillary acidic protein (GFAP). The postoperative recovery was uneventful and the followup CT scan showed no evidence of any residual tumor.Referral for radiotherapy treatment was made but the child's parents declined the treatment. A month later, the patient was readmitted because of bulging of the bone flap at the site of the craniotomy, which was associated with vomiting. He remained conscious and apart from a left homonomous hemianopia he had no neurological deficits. CT scan showed a large recurrence of the tumor at the same location. The craniotomy was reopened and a total macroscopic excision of the recurrence was performed. There was no evidence of tumor invasion of the dura or the bone flap. The dura was closed and the bone flap was replaced. The postoperative recovery was uneventful and the follow-up CT scan showed no evidence of residual tumor. Histology confirmed the diagnosis of a recurrent glioblastoma multiforme. On this occasion the patient received radiotherapy treatment to the whole cranium (4000 cGy over four weeks, with a daily dose of 200 cGy), and tolerated it well.

External compression caused by a massive extraperitoneal cerebrospinal fluid collection lead to intestinal obstruction in a 3-year-old child who had previously had a ventriculoperitoneal shunt for treatment of hydrocephalus. Radiological findings and ways of preventing this situation are discussed. A useful diagnostic radiological sign, the ‘coiling sign’, indicating shunt misplacement at the peritoneal level, is also described.

SUMMARYAneurysmal subarachnoid haemorrhage is a challenging pathology which remains a cause of considerable mortality and morbidity. To demonstrate to general practitioners the results of surgery for this condition a retrospective study of 160 consecutive cases who had undergone aneurysmal surgery was carried out. On admission 57% of cases had a good Hunt and Hess grade (grades I and II) and 43% a poor grade (grades III, IV and V). Twelve per cent of cases had a pre‐existing hypertension and 73% of cases were treated with nimodipine. Angiography was performed from 0 to 73 days (median 3 days) after the bleed. Early surgery (within the first three days after the bleed) was performed in 41% of cases. Twenty‐two per cent of cases rebled before surgery from 1 to 69 days after initial presentation (median seven days). Delayed cerebral ischaemia was diagnosed in 38% of cases, but only 15% of cases had evidence of low density on the CT scan.The outcome was determined at six months using the ‘Glasgow outcome scale’. Fifty‐five per cent of cases made a good recovery (back to normality), 15% a fair recovery (moderately disabled but independent), 15% a poor recovery (severely disabled and dependent), and 15% died. The significant poor prognostic factors were: a poor pre‐operative Hunt and Hess grade, the presence of an intracerebral haematoma or angiographic spasm, evidence of rebleeding and early surgery without treatment with nimodipine. Other factors which did not reach a statistical significance include: age, presence of subarachnoid and intraventricular blood on CT, timing of surgery, history of long‐standing hypertension, intraoperative rupture, and the development of hydrocephalus or delayed ischaemia.

½ The Neurosurgical Foundation Br J Neurosurg Downloaded from informahealthcare.com by Universiteit Twente on 11/30/14 For personal use only. Naim-ur-Rahman et al. Br J Neurosurg Downloaded from informahealthcare.com by Universiteit Twente on 11/30/14 For personal use only.